Background. The contribution of unsafe medical injections to HIV transmission in sub-Saharan Africa has been debated. In this study we examine the relationship between the number of medical injections and HIV serostatus among men and women in Uganda.
Methods. Data are from the 2004-05 Uganda HIV/AIDS Sero-Behavioural Survey (UHSBS), involving self-report data on medical injections and HIV testing among 8,298 men and 10,227 women age 15-59. The association between the number of medical injections a respondent received in previous 12 months and HIV serostatus was examined using multivariate logistic regression, accounting for possible reverse causation by excluding HIV-positive men and women who reported to be sick for at least 3 months in the previous 12 months, and adjusting for several risk factors and potential confounders, including self-reported sexually transmitted infections (STIs).
Results. Thirty-eight percent of men and 50% of women received at least one injection from a healthcare provider in the previous 12 months. The average number of medical injections per person per year was 1.9 for men and 2.5 for women. HIV prevalence was much higher among men (10.8%) and women (11.4%) who received five or more medical injections in the past year than among those who received no injections (4.0% among men and 6.3% among women). Men and women who received 3-4 injections also had higher HIV prevalence (6.6% among men and 8.3% among women) than those who had no injections. Even after accounting for several risk factors and potential confounders, men and women who received five or more injections were significantly more likely to be HIV-positive than those who had no injections (aOR=2.35, 95%CI:1.78-3.11 for men; aOR=1.55, 95%CI:1.24-1.94 for women). Excluding HIV-infected adults who were chronically ill in the past 12 months reduced the magnitude slightly, but the relationship remained significant (aOR=2.25, 95%CI:1.68-3.01 for men; aOR=1.47, 95%CI:1.17-1.85 for women).
Conclusions. Receiving frequent medical injections is associated with significantly higher probability of being HIV infected among Ugandan adults. Medical injection as a potential mode of HIV transmission deserves continued research and programmatic attention.
KEY WORDS: medical injections, injection safety, non-sexual transmission, HIV, AIDS, prevalence, Uganda